Early Treatment of Idiopathic Respiratory Distress Syndrome Using Binasal Continuous Positive Airway Pressure

Kamper, J; Ringsted, Charlotte

doi:10.1111/j.1651-2227.1990.tb11520.x

Cited by 48 publications

(19 citation statements)

References 20 publications

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“…The literature reports that early use of CPAP may reduce the need for intubation, [13][14][15] facilitate successful extubation, 16,17 and reduce the incidence of chronic lung disease. [18][19][20] The therapeutic effectiveness of CPAP is in part dependent on the ability to achieve and maintain a constant distending pressure. A variety of delivery systems and interfaces can be used to deliver CPAP, ranging from a flow meter connected to a traditional nasal cannula to a sophisticated mechanical ventilator.…”

Section: Discussionmentioning

confidence: 99%

“…23 Clinically important, and unpredictable levels of positive expiratory pressure were achieved only in the smallest infants and the highest flows, with the mouth fully closed. 19 This in vivo experiment was also limited by the inability to duplicate the variable occlusion of the nares and intranasal airway by secretions or welling, for example in this experimental model. The convenience of using conventional nasal cannula may enhance the ability of the neonate to participate in activities such as kangarooing and oral feeding, both of which have notable impacts on patient outcomes.…”

Section: Limitationsmentioning

confidence: 99%

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High Flow Through a Nasal Cannula and CPAP Effect in a Simulated Infant Model

Volsko

Fedor²,

Amadei

et al. 2011

Respir Care

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Teresa A Volsko MHHS RRT FAARC, Kathy Fedor RRT-NPS, Jason Amadei RRT, and Robert L Chatburn MHHS RRT-NPS FAARC BACKGROUND: Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. OBJECTIVE: To describe the relationship between the pressure generated at the airway opening and flow through a nasal cannula using a simulated infant model. We hypothesized that positive pressure generated by a standard cannula at flows > 2 L/min would be minimal and clinically unimportant. METHODS: Nares were simulated with holes drilled in a plastic fixture. A nares template for CPAP prongs served as a sizing template for the holes. Small, medium, and large nares fixtures were constructed and connected to a lung simulator that simulated spontaneous breathing. Respiratory muscle pressure was simulated by setting a waveform and adjusting the amplitude to deliver a range of tidal volumes (V T ) from 3 mL to 12 mL. Lung compliance and resistance were set at 0.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

High Flow Through a Nasal Cannula and CPAP Effect in a Simulated Infant Model

Volsko

Fedor²,

Amadei

et al. 2011

Respir Care

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“…Mechanical ventilation of the lungs has been shown to increase SP-D production (39). Probably the pressure delivered to the lungs by the nasal continuous positive airway pressure used to treat respiratory distress has the same effect (40). The number of sick infants was limited by the scope of our present study, but an ongoing study of SP-D levels in prematurely born infants is expected to elucidate the usefulness of SP-D as a biomarker of respiratory distress syndrome and infection.…”

mentioning

confidence: 93%

Surfactant Protein D in Newborn Infants: Factors Influencing Surfactant Protein D Levels in Umbilical Cord Blood and Capillary Blood

et al. 2005

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Surfactant protein D (SP-D) is a collectin that plays an important role in the innate immune system. The role of SP-D in the metabolism of surfactant is as yet quite unclear. The aims of this study were to establish normal values of SP-D in the umbilical cord blood and capillary blood of mature newborn infants and to assess the influence of perinatal conditions on these levels. A total of 458 infants were enrolled in the present study. Umbilical cord blood was drawn at the time of birth and capillary blood at age 4 to 10 d. The concentration of SP-D in umbilical cord blood and capillary blood was measured by enzyme-linked immunosorbent assay. The median concentration of SP-D in umbilical cord blood was 392.1 ng/mL and was found to be influenced by maternal smoking and labor. The median concentration of SP-D in capillary blood was 777.5 ng/mL and was found to be influenced by the mode of delivery, the highest levels being observed in infants born by cesarean section. It was concluded that SP-D concentrations in umbilical cord blood and capillary blood are highly variable and depend on several perinatal conditions. Further studies are needed to elucidate the effect of respiratory distress and infection on SP-D concentrations. Collectins are oligomeric molecules consisting of carbohydrate recognition domains attached to collagen-like regions (5). In humans, three well-studied collectins are known at present (6). These are MBL, which is a serum protein, SP-A, and SP-D. SP-A and SP-D are mainly produced in the epithelial cells of the lungs, but SP-D is also found in epithelial cells and secretory glands in the gastrointestinal tract and in other tissues (7). SP-D plays an important role in the innate immune defense by binding to specific carbohydrate and lipid structures on the surface of microorganisms: bacteria, viral particles, fungi, and protozoa (8 -11). This binding mediates effector mechanisms like aggregation, chemotaxis, mediation of phagocytosis, and permeabilization (12). Pulmonary infections in adults have been shown to cause significant changes in SP-D levels (13). Whether SP-D has a role in avoiding infections in newborn babies has to our knowledge not been investigated.Both structural and promoter variants are known for the MBL gene, and several alleles correlate with low values of MBL in serum and lead to an increased risk of infectious diseases in otherwise healthy children (14,15). Three polymorphisms have been identified in the coding sequence of human SP-D: codons corresponding to amino acid residue 11 (Met11Thr), residue 160 (Ala160Thr), and residue 270 (Ser270Thr) in the mature protein. Two clinical studies have associated the SP-D variants of amino acid 11 with disease. The SP-D allele coding for methionine 11 has been associated with severe respiratory syncytial virus infection in infants, whereas threonine 11 has been suggested to increase susceptibility to tuberculosis (16,17). However, the connection between structural genetic variance and serum SP-D has not been investigated. We have perfo...

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“…Amongst other reasons, this is a result of the advances in modern technology in neonatal medicine, although the 'standard' treatment of very preterm babies suffering from respiratory distress is still a matter for controversial discussion [1,8]. While early nasal continuous positive airway pressure (nCPAP) is preferred in Sweden, Denmark and some German and Swiss perinatal centres [20,23,24,30,31], and although the use of early nCPAP has increased over the years, other European and many American centres still tend to use early tracheal intubation followed by mechanical ventilation and a more aggressive treatment [5,7,36]. Some centres even intubate every child under 28 weeks of gestational age, as recently described by Vanpée et al [43].…”

Section: Introductionmentioning

confidence: 98%

Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP

et al. 2008

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In this paper, a retrospective study was performed to find out whether the introduction of early nasal continuous positive airway pressure (nCPAP) as a new standard regime of very low birthweight infants will lead to a decreasing tracheal intubation and ventilation rate, as well as to a lower incidence of bronchopulmonary dysplasia in a tertiary-level perinatal centre. Ninety-three infants (study group) with early nCPAP as the first respiratory support were compared to 63 infants (historical control group) born before the use of early nCPAP. No statistically significant differences were found in the baseline characteristics. The main results of the study include reduced intubation mainly in infants with a birthweight <1,000 g (study group): 58% vs. 81% (p < 0.05). The mean duration of ventilation was 248 h (control group) vs. 128 h (study group) (p < 0.001) and 437 h vs. 198 h in infants <1,000 g (p < 0.001). There was significantly reduced incidence of bronchopulmonary dysplasia from 55% to 18% for all surviving infants (p < 0.001), and for infants <1,000 g, it was 90% vs. 30% (p < 0.001). No significant differences for other outcome criteria were noted, but a significant reduction in the use of central i.v. lines, fluids, drugs, volume expansion, sedation, catecholamines, surfactant, steroids and buffer, as well as antibiotics, was observed (p < 0.05). Therefore, we can conclude that early nCPAP is an easy-to-use and safe procedure for very low birthweight infants to treat respiratory distress.

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Early Treatment of Idiopathic Respiratory Distress Syndrome Using Binasal Continuous Positive Airway Pressure

Cited by 48 publications

References 20 publications

High Flow Through a Nasal Cannula and CPAP Effect in a Simulated Infant Model

High Flow Through a Nasal Cannula and CPAP Effect in a Simulated Infant Model

Surfactant Protein D in Newborn Infants: Factors Influencing Surfactant Protein D Levels in Umbilical Cord Blood and Capillary Blood

Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP

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